Influence of COVID-19 Pandemic on Health-care Workers’ Hand Hygiene Practice at a Private Academic Hospital in Johannesburg, South Africa: A Quantitative and Qualitative Longitudinal Study

Abstract

ABSTRACT Background: Hand hygiene (HH) is a cornerstone infection prevention measure and is crucial in the fight against the COVID-19 pandemic. Improving and monitoring of HH compliance in a hospital setting is a complex challenge given the behavioural component associated with it. We aimed to assess the impact of the COVID-19 pandemic on HH compliance using both quantifiable hand product usage and observational data. Methods: Using the hospital's HH usage monitoring system, the quantity of different HH products per nursing unit, expressed as millilitres (mL) per patient bed day (PBD), was analysed longitudinally during the course of the pandemic. Observational HH compliance data was drawn from the hospital audit system for comparison. Results: Across all units, there was a significant increase in HH product usage coinciding with the onset of the pandemic (53 mL/PBD to 111 mL/PBD, in non-critical care units (non-CCU's); 127 mL/PBD to 217 mL/PBD, in CCU's). This increase was largely attributable to an increase in alcohol-based hand rub usage. Discordance with observed compliance rates was noted. Conclusion: An unprecedented increase in HH product usage in a hospital setting was seen to coincide with the onset of the COVID-19 pandemic. No specific HH campaign was introduced, and the improved usage compliance appears to be driven primarily by health-care workers’ own behavioural change.